Provider Demographics
NPI:1265686497
Name:SPARACINO, ANTHONY DOMINIC (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DOMINIC
Last Name:SPARACINO
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:DOMINIC
Other - Last Name:SPARACINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:1480 E. BETHANY HOME RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014
Mailing Address - Country:US
Mailing Address - Phone:602-677-7550
Mailing Address - Fax:
Practice Address - Street 1:1480 E. BETHANY HOME RD
Practice Address - Street 2:SUITE 230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-677-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14084101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional